PROCEDURES

LAPAROSCOPY, OVARIAN CYSTECTOMY OR LYSIS OF ADHESIONS

Description: Cysts are fluid filled structures on the ovary. They may be of various types but the simplest ones are follicular cysts which females produce with ovulation each month and these are usually nothing to worry about. Other types may be hemorrhagic cysts, dermoid cysts or cancerous cysts. Adhesion formation is a common occurrence in ladies who have undergone previous surgeries or as a sequele to infections in the lower abdomen and pelvis. Adhesions are bands of tissue which are between the uterus, tubes, ovaries and other structures including intestines, bladder, pelvic sidewall etc. This can result in chronic pelvic pain and other tests including sonogram, CT scan and MRI are negative for bowel, urinary and gynecological disease

Why surgery: In patients with adhesions after all the tests have been done and cannot explain the pain and the patient is tired of living in pain, surgery may be an option. Remember, this is a diagnosis of exclusion. Persistent ovarian cysts more than 8 cm may also need removal.

Preparation: Preparation for such a procedure requires stopping Aspirin and other NSAID’s e.g motrin, advil, aleve or etc for 1 week prior to surgery. Patients are advised to take a bowel cleanser the day before the procedure. They may have a fluid diet the night before surgery so as not to offset the effect of bowel cleansing. On the morning of surgery they may brush their teeth.

Hospital admission: The morning of the surgery you will be required to go to the first floor of the hospital to the presurgical unit where you will be greeted by our efficient and cordial staff. They will prepare you for surgery and at the time of the procedure you will be brought up to the operating room. A second team of nurses will check everything again, that was checked on the first floor as a second level of precautions. Soon the operating room nurse will come and check everything for a third time for your security. Please do not get annoyed, we are all working to ensure that your safety is not compromised.

Post op recovery: At the completion of the procedure you will be gently taken from the surgical table to the stretcher which will take you to the recovery room. This is a special unit with nurses dedicated to the recovery of the patients. Once the nurses see that you can safely go home they will let you depart with your family or friends to the comfort of your home. Any suspicion that you may have problems at home they will contact me to see if it is safer for you to stay in the hospital for the night.

Post surgical home recovery: You will be sent home when we are all comfortable that you can take care of yourself at home. You will be allowed to walk around, eat and drink normally and be given pain medications to keep you comfortable. You may have shoulder and chest pain due to the carbon dioxide used during the procedure, do not worry, this is perfectly normal. Some people resume work in 1-2 weeks, some take up to six weeks.

What to expect from this type of surgery: This is a complicated surgery with the intestines near the scar tissues that we call adhesions. There may be immediate injury either by direct contact or thermal injury, or later after a few hours or days needing another surgery. Although every attempt is made to prevent these injuries even in the best of hands it is a possibility. The risk of bladder injury and other structures are also a possibility. If you are afraid of the risks then you may be better off considering open lysis of adhesions by laparotomy or open ovarian cystectomy.

LAPAROSCOPIC ROBOTIC HYSTERECTOMY

Definition: Removal of the uterus with or without the cervix is called hysterectomy. The reasons to remove the uterus are many and the main reason is heavy bleeding not responding to conventional methods.

    Robotic Hysterectomy can be :

a. Laparoscopic robotic vaginal hysterectomy when part of the hysterectomy is done through the vagina.
b. Laparoscopic robotic total hysterectomy when the uterus can be freed up laparoscopically and is removed through the vagina.
c. Laparoscopic robotic supracervical hysterectomy, when the uterus is too large to remove from below, it is incised at the level of the cervix and removed from the abdomen in smaller pieces using the morcellator.

Why surgery: After all other methods have been offered to the patients a) Observation b) Oral contraceptives c) Lupron d) Uterine artery embolization e) endometrial ablation. Only after the patient has studied and decided against the above procedures do we proceed with this type of surgery as a last resort.

Preparation: : Preparation for such a procedure requires stopping Aspirin and other NSAID’s e.g motrin, advil, aleve etc for 1 week prior to surgery. Patients are advised to take a bowel cleanser the day before the procedure. They may have a fluid diet the night before surgery so as not to offset the effect of bowel cleansing. On the morning of surgery they may brush their teeth.

Hospital admission:The morning of the surgery you will be required to go to the first floor of the hospital to the pre-surgical unit where you will be greeted by our efficient and cordial staff. They will prepare you for surgery and at the time of the procedure you will be brought up to the operating room. A second team of nurses will check everything again, that was checked on the first floor as a second level of precautions. Soon the operating room nurse will come and check everything for a third time for your security. Please do not get annoyed, we are all working to ensure that your safety is not compromised.

Post op recovery: At the completion of the procedure you will be gently taken from the surgical table to the stretcher which will take you to the recovery room. This is a special unit with nurses dedicated to the recovery of the patients from anesthesia. Once the nurses see that you can safely go to your room they will let you be transported by stretcher to the comfort of your room. You will usually given a regular diet and if you feel strong enough you will be asked to sit in a chair or ambulate if you so choose. The next day after evaluation you may be discharged home if you are strong enough.

Post surgical home recovery: You will be sent home when we are all comfortable that you can take care of yourself at home, probably the day after surgery. You will be allowed to walk around, eat and drink normally and be given pain medications to keep you comfortable. You may have shoulder and chest pain due to the carbon dioxide used during the procedure, do not worry this is perfectly normal. Some people resume work in 1-2 weeks, some take up to six weeks.

What to expect from this type of surgery: This is a time consuming surgery with the intestines and other structures near the uterus tubes and ovaries. There may be immediate injury to other structures either by direct contact or thermal injury, or later after a few hours or days needing another surgery. Although every attempt is made to prevent these injuries even in the best of hands, it is a possibility. The risk of bladder injury and other structures are also a possibility. If you are afraid of the risks then you may consider open surgery which has a lengthier recovery but slightly fewer direct injuries.

LAPAROSCOPIC HYSTERECTOMY

Description: Removal of the uterus with or without the cervix is called hysterectomy. The reasons to remove the uterus are many and the main reason is heavy bleeding not responding to conventional methods.

    Laparoscopic Hysterectomy can be done as:

a. Laparoscopic assisted vaginal hysterectomy when part of the hysterectomy is done through the vagina.
b. Laparoscopic total hysterectomy when the uterus can be freed up laparoscopically and is removed through the vagina.
c. Laparoscopic supracervical hysterectomy, when the uterus is too large to remove via the vagina. it is incised at the level of the cervix and removed from the abdomen in smaller pieces using the morcellator and the cervix is left in the body.

Why surgery: After all other methods have been offered to the patients:

  1. Observation
  2. Oral contraceptives
  3. Uterine artery embolization
  4. Endometrial ablation

Only after the patient has studied and decided against the above procedures do we proceed with this type of surgery as a last resort.

Preparation: Preparation for such a procedure requires stopping Aspirin and other NSAID’s e.g motrin, advil, aleve etc for 1 week prior to surgery. Patients are advised to take a bowel cleanser the day before the procedure. They may have a fluid diet the night before surgery so as not to offset the effect of bowel cleansing. On the morning of surgery they may brush their teeth.

Hospital admission: The morning of the surgery you will be required to go to the first floor of the hospital to the pre-surgical unit where you will be greeted by our efficient and cordial staff. They will prepare you for surgery and at the time of the procedure you will be brought up to the operating room. A second team of nurses will check everything again, that was checked on the first floor as a second level of precautions. Soon the operating room nurse will come and check everything for a third time for your security. Please do not get annoyed, we are all working to ensure that your safety is not compromised.

Post op recovery: At the completion of the procedure you will be gently taken from the surgical table to the stretcher which will take you to the recovery room. This is a special unit with nurses dedicated to the recovery of the patients from anesthesia. Once the nurses see that you can safely go to your room they will let you be transported by stretcher to the comfort of your room. You will usually given a regular diet and if you feel strong enough you will be asked to sit in a chair or ambulate if you so choose. The next day after evaluation you may be discharged home if you are strong enough.

Post surgical home recovery: You will be sent home when we are all comfortable that you can take care of yourself at home, probably the day after surgery. You will be allowed to walk around, eat and drink normally and be given pain medications to keep you comfortable. . You may have shoulder and chest pain due to the carbon dioxide used during the procedure, do not worry this is perfectly normal. Some people resume work in 1-2 weeks, some take up to six weeks .

What to expect from this type of surgery: This is a time consuming surgery with the intestines and other structures near the uterus tubes and ovaries. There may be immediate injury to other structures either by direct contact or thermal injury, or later after a few hours or days needing another surgery. Although every attempt is made to prevent these injuries even in the best of hands, it is a possibility. The risk of bladder injury and other structures are also a possibility. If you are afraid of the risks then you may consider open surgery which has a lengthier recovery but slightly fewer direct injuries.

VAGINAL HYSTERECTOMY

Definition: Removal of the uterus with the cervix through the vagina is called vaginal hysterectomy. The reasons to remove the uterus are mainly for the management of prolapse usually grade 3 or 4, but sometimes also for heavy vaginal bleeding when there is descent of the uterus.

Why surgery: After other methods have been offered to the patients:

a. Observation
b. Pessary

Preparation: Preparation for such a procedure requires stopping Aspirin and other NSAID’s e.g motrin, advil, aleve etc for 1 week prior to surgery. Patients are advised to take a bowel cleanser the day before the procedure. They may have a fluid diet the night before surgery so as not to offset the effect of bowel cleansing. On the morning of surgery they may brush their teeth but are advised not to eat or drink anything.

Hospital admission: The morning of the surgery you will be required to go to the first floor of the hospital to the pre-surgical unit where you will be greeted by our efficient and cordial staff. They will prepare you for surgery and at the time of the procedure you will be brought up to the operating room. A second team of nurses will check everything again, that was checked on the first floor as a second level of precautions. Soon the operating room nurse will come and check everything for a third time for your security. Please do not get annoyed, we are all working to ensure that your safety is not compromised.

Post op recovery: At the completion of the procedure you will be gently taken from the surgical table to the stretcher which will take you to the recovery room. This is a special unit with nurses dedicated to the recovery of the patients from anesthesia. Once the nurses see that you can safely go to your room they will let you be transported by stretcher to the comfort of your room. You will usually given a regular diet and if you feel strong enough you will be asked to sit in a chair or ambulate if you so choose. The next day after evaluation you may be discharged home if you are strong enough.

Post surgical home recovery: You will be sent home when we are all comfortable that you can take care of yourself at home, probably the day after surgery. You will be allowed to walk around, eat and drink normally and be given pain medications to keep you comfortable. Some people resume work in 1-2 weeks, some take up to six weeks.

What to expect from this type of surgery: This is delicate surgery with the intestines, bladder and other structures near the uterus tubes and ovaries. There may be immediate injury to other structures either by direct contact or thermal injury, or later after a few hours or days needing another surgery. Although every attempt is made to prevent these injuries even in the best of hands, although extremely rare it is a possibility. The risk of bladder injury and other structures are also a possibility.